Health-related quality of life worse in NAFLD patients compared with general population
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LONDON — Patients with nonalcoholic fatty liver disease had worse health-related quality of life, regardless of fibrosis stage, compared with the general population, according to research presented at the International Liver Congress.
“Health-related quality of life has been shown to be impaired in NAFLD patients and potentially associated with fibrosis severity, obesity or other metabolic comorbidities,” Margarita Papatheodoridi, MD, PhD, a post-doctoral research fellow at the University College of London’s Royal Free Hospital Institute for Liver and Digestive Health, said. “It is still uncertain whether quality of life is impaired in NAFLD patients without advanced fibrosis or cirrhosis vs. the general population and whether these impairments are driven by the presence of fibrosis or other liver comorbidities.”
In a prospective, multicenter study, 561 patients with NAFLD from four U.K. secondary care centers completed the EQ-5D-5L and Chronic Liver Disease Questionnaire (CLDQ) between 2016 and 2019 to assess quality of life. Papatheodoridi and colleagues also collected patient information on demographics and clinical history, liver stiffness, liver biopsy results and history of cirrhosis.
Researchers used propensity score matching and reports from a general population sub-cohort survey of people without alcohol misuse to compare health-related quality of life (HRQL). The primary endpoint was the assessment of HRQL among patients with NAFLD compared with the general population; secondary endpoints included the association of fibrosis severity and metabolic comorbidities with HRQL impairments.
According to study results, 514 NAFLD patients had lower EQ-5D-5L index scores compared with 514 propensity-matched healthy controls (0.762 ± 0.276 vs. 0.844 ± 0.2); this difference also was evident among a subgroup of NAFLD patients without advanced fibrosis compared with the general population (0.781 ± 0.276 vs. 0.845 ± 0.2). Compared with NAFLD patients without cirrhosis, patients with NAFLD and cirrhosis had lower EQ-5D-5L index, EQ-visual analog scale (VAS) and CLDQ scores.
Researchers observed no difference among patients with nonalcoholic steatohepatitis regardless of advanced fibrosis but did associate liver stiffness with lower HRQL scores in the whole patient population and patients without cirrhosis.
Multivariate analysis further showed the EQ-5D-5L index negatively correlated with type 2 diabetes, depression and osteoarthritis among both the whole patient population as well as in patients without cirrhosis and EQ-VAS associated with age, sex, BMI, depression and osteoarthritis.
Lower CLDQ scores correlated with younger age, male sex, type 2 diabetes, ischemic heart disease, depression and osteoarthritis among all patients and lower CLDQ correlated with male sex, type 2 diabetes and depression among the sub-group of patients without cirrhosis.
“HRQL is similar for NASH patients with and without advanced fibrosis and HRQL is independently associated with non-liver comorbidities but not liver stiffness,” Papatheodoridi concluded. “Multi-disciplinary management is required for all NAFLD patients irrespectively of their disease severity.”
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Papatheodoridi M, et al. Abstract OS044. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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